Infusion flow guidewire system

ABSTRACT

An infusion flow guidewire and a system including an infusion flow guidewire. The minimal cross section flexible infusion flow guidewire includes a nitinol hypotube, a flexible tip having a closed distal end, a coil, a core wire and at least one distally located rearwardly directed jet orifice for infusion of fibrinolytics and for introduction of high pressure fluids for maceration and rearwardly directed flow of thrombus debris located in tortuous small sized vessels. Apparatus, some of which is removably attachable, is provided in the system for grasping members of the invention for rotational torqueing and for longitudinal actuation along and within the vasculature.

CROSS REFERENCES TO RELATED APPLICATIONS

This patent application is related to patent application Ser. No.11/702,990 filed Feb. 6, 2007, entitled “Miniature Flexible ThrombectomyCatheter,” which is pending; to patent application Ser. No. 11/702,995filed Feb. 6, 2007, also entitled “Miniature Flexible ThrombectomyCatheter,” which is pending; to patent application Ser. No. 11/237,558filed Sep. 28, 2005, entitled “Thrombectomy Catheter Deployment System,”which is pending; and to patent application Ser. No. 11/581,613 filedOct. 16, 2006, entitled “Occlusive Guidewire System Having an ErgonomicHandheld Control Mechanism Prepackaged in a Pressurized GaseousEnvironment and a Compatible Prepackaged Torqueable Kink-ResistantGuidewire with Distal Occlusive Balloon,” which is pending.

This application claims priority from the earlier filed U.S. ProvisionalApplication No. 60/934,281 filed Jun. 12, 2007, entitled “Floppy FlowWire”, and is hereby incorporated into this application by reference asif fully set forth herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The field of the present invention relates to mechanical thrombectomyand catheter directed thrombolysis and for use in neurologic arterieswhere vessels are characterized by difficulty to deliver ablationdevices thereinto due to the small size of the vessel and thetortuousity of the vessels. High efficacy of any thrombus or clotremoving device is highly desirable when dealing with the removal oforganized and difficult to remove materials which have been expelledfrom the left atrium or aorta. Furthermore, a guidewire-type catheterthat is highly deliverable, such as by the use of a 0.014 inch guidewiresuch as provided by the present invention, can be utilized in the distalarteries of the coronary or peripheral arteries especially when such acatheter must be delivered through diseased vessel segments since it hasa small crossing profile and is structurally suited for such a task.

2. Description of the Prior Art

Prior art devices such as thrombectomy catheters and closely relateddevices have been previously developed and designed to access and treatsites along the neurological anatomy. Such devices included catheterswhich were delivered within the vasculature in two parts. First, amicrocatheter which is essentially a tube functioning as the effluentlumen of the thrombectomy catheter would be delivered to the treatmentsite over a guidewire. Then, a nitinol jet body with a guidewire tip onit was delivered inside the microcatheter to the treatment site. The jetbody is the part of the thrombectomy catheter that delivers saline tothe distal end of the catheter. The jet body has small jet orifices thatare partly responsible for the high back pressures developed by thecatheter. The jet orifices are positioned to direct high speed fluid jetstreams within the catheter body. In previous neurological thrombectomycatheters, the jet body was designed to include a short skirt. When thejet body was activated by pumped saline, recovered pressures within thecatheter assembly would expand the skirt such that the two parts becamea unified single catheter assembly. The sequential exchange of devicesmeant that no guidewire was in place once the jet body was delivered.Hence, there was ample lumen for suitable exhaust flow and the cathetersize could be kept smaller due to the absence of a guidewire. Generally,this two-part configuration for delivery to access and treat the sitewas difficult to accomplish. Some microcatheters would actually stretchwhile the jet body was advanced through the lumen, hence the jet bodywas never exposed to enable its activation. On occasions, themicrocatheter would ovalize or otherwise distort in a tortuous anatomy,thus making it difficult to deliver the jet body through such amisshaped lumen. Furthermore, interventionalists are never comfortablegiving up their wire position and removing the guidewire in exchange fora jet body was regarded as a bit awkward and non-intuitive. Previousversions of neurologic thrombectomy catheters were often underpoweredfor the tough thrombus that was found in embolic stroke patients(organized thrombus from the left atrium). With any given AngioJet®style catheter design, there is a tradeoff between the thrombectomypower of the catheter and the vessel safety of that catheter design. Theessence of the problem is that neurological arteries are highly fragilesince they have very thin and unsupported vessel walls and the clotmaterial adhering thereto is tough and organized.

Currently produced 3Fr catheters are designed to be more easilydeliverable to small distal vessels and they are envisioned to be animprovement over first generation products. The 3Fr catheters have atransitioned sized hypotube assembly which is intended to achieve alevel of deliverability far superior to the currently available 4Frcatheters and, due to their smaller profile, will greatly enhance theirdeliverability. Nevertheless, the 3Fr catheter will not achieve thelevel of deliverability of a 0.014 inch infusion flow guidewire asdiscussed in the present invention. The crossing profile of 1.07Fr ofthe 0.014 inch infusion flow guidewire versus the 3Fr catheter is ofsubstantial benefit. Furthermore, a catheter that rides over a guidewirewill interact with the guidewire creating a drag which will diminish theultimate deliverability of the catheter device, whereas a 0.014 inchinfusion flow guidewire of the present invention does not have thisproblem.

SUMMARY OF THE INVENTION

The general purpose of the present invention is to provide a highlydeliverable infusion flow guidewire having a substantialthrombectomy/fibrinolytic infusion effectiveness.

According to one or more illustrations of the present invention, thereis provided an infusion flow guidewire system that is preferably usedwith an external pressurized fluid supply, such as an AngioJet® pump setor other suitable device. The infusion flow guidewire system iscomprised of major structures including: an infusion flow guidewire; adelivery sheath having a proximally located torque handle; and a torquedevice which can be removably attached to the proximal end of theinfusion flow guidewire to facilitate the connection of the proximal endof the infusion flow guidewire to the distal end of an externalpressurized fluid supply.

The infusion flow guidewire is comprised of components whichtransitionally provide for increasing flexibility along the length ofthe infusion flow guidewire where the most flexible region of theguidewire is at the distal end thereof. A major portion of the infusionflow guidewire is a hypotube of flexible nitinol material which is drawndown to a reduced diameter section near the distal end thereof providingone portion thereof with increased flexibility. The drawn-down distalend of the flexible hypotube, herein referred to as the drawn hypotubesection, extends through a reinforcement collar and is secured thereinby laser welds, soldering, welding or other suitable method, anddistally extends further a short distance to terminate and secure withinthe proximal end of an even more flexible coil of platinum. The proximalround end of a flexible gold-plated core wire is located and securedwithin the distal end of the drawn hypotube section of the flexiblehypotube. It is in coaxial alignment with the distal end of the drawnhypotube section of the flexible hypotube and with the proximal portionof the flexible coil of platinum. It is mutually secured by laserswages, soldering, welding or other suitable method. The proximal roundsection of the flexible gold-plated core wire extends partially in adistal direction along and within the flexible coil of platinumpreferably tapering along a distal direction to continually reduce thecross section. The round tapered shape of the flexible gold-plated corewire transitions into an even more flexible flat shape to extend alongthe distal region of the flexible coil of platinum. A flexible tiphaving shapeable attributes is comprised of a distal tip weld andportions of both the flexible coil and the core wire distal to theflexible coil. One or more rearwardly directed jet orifices extendthrough the reinforcement collar and through the drawn hypotube sectionfor rearwardly directed jet flow therefrom.

A coupling assembly is provided for rapid connection of the proximal endof the infusion flow guidewire to a high pressure supply device, such asthe AngioJet® pump set or other suitable device. The delivery sheath,including a proximally located torque handle, is provided for fixing theposition of the delivery sheath with respect to the infusion flowguidewire or for combined unitary maneuvering thereof, as required.

SIGNIFICANT ASPECTS AND FEATURES OF THE PRESENT INVENTION

One significant aspect and feature of the infusion flow guidewiresystem, the present invention, is the use of an infusion flow guidewirewith a delivery sheath.

One significant aspect and feature of the infusion flow guidewire is theuse of high velocity fluid jet streams for drug infusion.

One significant aspect and feature of the infusion flow guidewire is theuse of high velocity fluid jet streams for tissue maceration.

One significant aspect and feature of the infusion flow guidewire is theuse of high velocity fluid jet streams for moving debris in a preferreddirection.

Yet another significant aspect and feature of the infusion flowguidewire is the use of nitinol tubing for the body of the infusion flowguidewire for the purpose of kink resistance.

Another significant aspect and feature of the present invention is theuse of a laser swaging technique for attaching a gold-plated flexiblestainless steel guidewire tip core wire to a nitinol hypotube.

Still another significant aspect and feature of the present invention isthe use of a nitinol hypotube for the body of the infusion flowguidewire for the purpose of maximizing flow rate, i.e., minimizing flowresistance by maximizing ID.

Yet another significant aspect and feature of the present invention isthe use of a nitinol hypotube for the body of the infusion flowguidewire for the purpose of minimizing complex joints betweendissimilar metals.

A further significant aspect and feature of the present invention is adelivery sheath for support in delivering the infusion flow guidewireand to aid in giving the guidewire a 1:1 torque ratio which is preferredfor guidewires.

A still further significant aspect and feature of the present inventionis a flow guidewire performing substantially as a 0.014 inch outerdiameter guidewire.

A still further significant aspect and feature of the present inventionis the use and design of an easily detachable coupling assemblyconnecting an infusion flow guidewire to a high pressure supply line anda high pressure supply.

A still further significant aspect and feature of the present inventionis the use of a coupling assembly using collet and O-ring assemblies tograsp or provide a seal about the proximal end of an infusion flowguidewire.

A still further significant aspect and feature of the present inventionis the use of a coupling assembly to removably secure to androtationally and/or longitudinally maneuver an infusion flow guidewire.

A still further significant aspect and feature of the present inventionis the use of a torque handle using a collet to grasp an infusion flowguidewire.

A still further significant aspect and feature of the present inventionis the use of the components of a torque handle to secure to androtationally and/or longitudinally maneuver a hypotube and/or a deliverysheath either unitarily or singly.

A still further significant aspect and feature of the present inventionis a 0.014 inch infusion flow guidewire driven by a pressure exceeding0.10 kpsi with a delivered flow rate in excess of 3 cc/min.

A still further significant aspect and feature of the present inventionis a fluid jet stream velocity for a 0.014 inch infusion flow guidewirebetween 0.1 and 100 m/s.

A still further significant aspect and feature of the present inventionis a fluid jet stream velocity for a 0.014 inch infusion flow guidewiregreater than 100 m/s.

A still further significant aspect and feature of the present inventionis the use of fluid jet streams emanating from the infusion flowguidewire in any direction (i.e., 360 degrees from the axis of thewire), such as distally, proximally, perpendicularly or combined anddiverse direction.

A still further significant aspect and feature of the present inventionis use of one or more fluid jet streams.

A still further significant aspect and feature of the present inventionis use of round jet orifices with diameters greater than 0.001 inch andless than the diameter of the wire, although the jet orifices could benoncircular or elongated in shape or in other geometrically configuredshapes.

A still further significant aspect and feature of the present inventionis that this high pressure high velocity jet technology could also beused for larger guidewires with a 0.018 inch diameter or a 0.035 inchdiameter, or guidewires with less than 0.045 inch diameter.

A still further significant aspect and feature of the present inventionis the use of a stainless steel guidewire extension with an irregularlyshaped distal end or with a conical shaped distal end which isaccommodated by the inner diameter of the hypotube to increase thelength of an infusion flow guidewire rapid exchange wire to function asan exchange length wire for over-the-wire device use.

A still further significant aspect and feature of the present inventionis the use of the infusion flow guidewire with the Thrombectomy CatheterDeployment System disclosed in patent application Ser. No. 11/237,558(The AngioJet® Ultra Console) by the inventors.

Yet a further significant aspect and feature of the present invention isto use the present invention in combination with other devices, such asa regular AngioJet® catheter, simple syringe suction catheters, rollerpump facilitated suction or in an exhaust-pressure-operated ballooncatheter system (Proxy Cat) disclosed in patent application Ser. No.11/294,006 by the inventors or with other devices.

Having thus briefly described embodiments of the present invention andhaving mentioned some significant aspects and features of the presentinvention, it is the principal object of the present invention toprovide an infusion flow guidewire system.

BRIEF DESCRIPTION OF THE DRAWINGS

Other objects of the present invention and many of the attendantadvantages of the present invention will be readily appreciated as thesame becomes better understood by reference to the following detaileddescription when considered in connection with the accompanyingdrawings, in which like reference numerals designate like partsthroughout the figures thereof and wherein:

FIG. 1 is an isometric view of the infusion flow guidewire system wherethe major components of the system are shown separated, the presentinvention;

FIG. 2 is an isometric view of the infusion flow guidewire system in theengaged form;

FIG. 3 is an assembled view of the drawn hypotube section and theflexible tip components of the guidewire system;

FIG. 4 is an exploded view of the components of FIG. 3;

FIG. 5 shows views along section lines 5A-5A, 5B-5B, 5C-5C, and 5D-5D ofFIG. 3;

FIG. 6 is an exploded isometric view of a torque handle;

FIG. 7 is an exploded vertical cross section view of the components ofFIG. 6;

FIG. 8 is a view of the components shown in cross section in FIG. 7arranged as an assembly;

FIG. 9 is an exploded isometric view of a coupling assembly;

FIG. 10 is an exploded vertical cross section view of the components ofFIG. 9;

FIG. 11 is a view of the components shown in cross section in FIG. 10arranged as an assembly;

FIG. 12 illustrates an extension wire for use with the preferred nitinolwire infusion flow guidewire;

FIG. 12 a is an isometric view of an alternate distal end shape for theextension wire of FIG. 12;

FIG. 13 shows the location of the jet orifices in close proximity to andproximal to the thrombus;

FIG. 14 shows the location of the jet orifices in close proximity to anddistal to the thrombus; and,

FIG. 15 shows the location of the jet orifices aligned within thethrombus.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 is an isometric view of the infusion flow guidewire system 10wherein the major components are shown separated. FIG. 2 is an isometricview of the components of the infusion flow guidewire system 10 in theengaged form. Each figure illustrates readily visible componentsincluding: a flexible infusion flow guidewire 12 having a couplingassembly 14 removably attached at the proximal end thereof and aflexible delivery sheath 16 (also known as a guide catheter) of braidedpolyimide preferably having an outside diameter of 0.035 inch and aninner diameter of 0.017 inch. A proximally located torque handle 18 isshown attached to the proximal end of the delivery sheath 16. Specialattention is paid to the connecting structure in the form of a highpressure supply line 20 which enables connection between an AngioJet®pump set (or another suitable device) and the infusion flow guidewire 12where the high pressure supply line 20 does not exceed an infusion flowguidewire 12 having an outer diameter of 0.014 inch in order to enablethe exchange of 0.014 inch compatible devices and does not impinge theinner diameter of 0.010 inch at the proximal end infusion flow guidewire12 in order to provide for a suitable flow therethrough. For reference,the section of high pressure supply line 20 to which the invention canbe attached is also shown in alignment with the proximal end of thecoupling assembly 14.

The infusion flow guidewire 12 includes a hypotube 22 (a high pressuretube), preferably of flexible nitinol, at least one proximally directedjet orifice 32, 34 (FIG. 5), and a flexible tip 24, and other componentsdescribed later in detail. Preferably, the greater portion of thehypotube 22 has an outer diameter of 0.014 inch and in inner diameter of0.010 inch The hypotube 22 also includes a distally located drawnhypotube section 22 a of reduced diameter for increased flexibility ofthe distal portion of the infusion flow guidewire 12. The multiplecomponent shapeable and flexible tip 24, also shown in FIG. 3, which islocated distally on the drawn hypotube section 22 a, provides aflexibility greater than that of the drawn hypotube section 22 a.

With reference to FIGS. 3, 4 and 5, each figure shows different views inincreasing detail exemplifying the generally overlapping and coaxialrelationship of components of the flexible tip 24 to each other and tothe drawn hypotube section 22 a. The overlapping relationships andstructure of such components are now described where FIG. 3 is anassembled view, FIG. 4 is an exploded view of the components of FIG. 3,and where FIG. 5 shows views along section lines 5A-5A, 5B-5B, 5C-5C,5D-5D and 5E-5E of FIG. 3.

The complete length of a nitinol reinforcement collar 26 in the form ofa tube (0.014 inch OD by 0.010 inch ID for purpose of example andillustration) is aligned over and about a distal region of the drawnhypotube section 22 a at the distal end of the hypotube 22 and issecured thereto by laser welds 28 and 30 as shown in FIG. 5. As shown insection line 5 b-5 b of FIG. 5, a unitary rearwardly directed jetorifice 32 is provided by a hole 32 a in the reinforcement collar 26 inclose alignment with a hole 32 b in the distal region of the drawnhypotube section 22 a and, correspondingly, another unitary rearwardlydirected jet orifice 34 is provided by a hole 34 a in the reinforcementcollar 26 in close alignment with a hole 34 b in the distal region ofthe drawn hypotube section 22 a. The reinforcement collar 26 provides astructural support along and about the drawn hypotube section 22 a inthe region of the jet orifices 32 and 34. The rearwardly directed jetorifices 32 and 34 are used to direct high pressure fluid jet streamsproximally, as later described in detail. One or more such rearwardlydirected jet orifices, such as jet orifices 32 and 34, may be formed byelectrical discharge machining or by other suitable processes. Althoughsymmetric rearwardly directed orifices 32 and 34 are shown, othersymmetric or asymmetric jet orifice configurations can be used includingone or more orifices which can be rearwardly, forwardly, perpendicularlydirected in one or more directions or combinations of directions.

At the distal region of the infusion flow guidewire 12, the proximal endof a flexible coil 36 (preferably of, but not limited to, platinum) isaligned over and about the distal end of the drawn hypotube section 22 aand can be soldered, welded or otherwise suitably secured thereto. Theproximal terminus of the flexible coil 36 is aligned with the distalterminus end of the reinforcement collar 26 and can be soldered, welded,or otherwise suitably secured thereto.

A flexible core wire 38 of gold-plated steel consists of a core wireround section 38 a with a contiguous core wire flat section 38 b of thesame material. The core wire 38 is attached to the distal end of thedrawn hypotube section 22 a and extends distally therefrom and is incoaxial alignment with the flexible coil 36 along the inner lengththereof. More specifically, the proximal end of the core wire roundsection 38 a is aligned within the lumen 40 of the drawn hypotubesection 22 a. At the distal end of the drawn hypotube section 22 a, thecore wire round section 38 a is in direct coaxial alignment within theinner and distal portion of the drawn hypotube section 22 a and inindirect coaxial alignment with the proximal portion of the flexiblecoil 36. The proximal end of the gold-plated core wire round section 38a is secured to the inner wall of the drawn hypotube section 22 a bylaser swages 43 a, 43 b and 43 c by the process referred to in relatedpatent application No. 11/702,990 filed Feb. 6, 2007, entitled“Miniature Flexible Thrombectomy Catheter,” and to patent applicationSer. No. 11/702,995 filed Feb. 6, 2007, also entitled “MiniatureFlexible Thrombectomy Catheter,” describing the process and use of laserswaging of gold-plated components to nitinol components. Such laserswaging of components, as described therein, provides for superiorattachment and connection of the proximal end of the gold-plated corewire round section 38 a to the drawn hypotube section 22 a withoutdegrading or weakening the swaged components. Preferably, the diameterof the core wire round section 38 a is reduced in a distal directiontransitioning to the flattened profile of the core wire flat section 38b. The core wire flat section 38 b extends along the inner and distalportion of the flexible coil 36, thus providing an increased flexibilityalong the length of the flexible core wire 38. The distal terminus ofthe core wire flat section 38 b is secured to the distal terminus of theflexible coil 36, such as by a weld 41.

With reference to FIGS. 6, 7 and 8, each figure shows the relationshipsof components of the torque handle 18 to each other, to the hypotubesection 22 and to the delivery sheath 16. The relationships and thestructure of such components are now described where FIG. 6 is anexploded isometric view of the torque handle, FIG. 7 is an explodedvertical cross section view of the components of FIG. 6, and FIG. 8 is aview of the components shown in cross section in FIG. 7 arranged as anassembly.

The torque handle 18 includes a torque body 42, a collet 44, a colletnut 46, and a strain relief 48 having a passage 49, the assembly ofwhich provides for the coaxial accommodation of the delivery sheath 16and the hypotube 22. The torque body 42 is generally cylindrical inshape and includes a centrally located bore 50, proximally locatedexternal threads 52, and a proximally located annular tapered actuatingsurface 54 located between the proximal end of the bore 50 and theproximal end of the threads 52. The centrally located bore 50accommodates portions of one or more components including the hypotube22, the delivery sheath 16, and one end of the strain relief 48 incoaxial fashion. An annular positioning ring 56 is also located aboutthe exterior of the torque body 42.

The collet 44, as generally known in the art, includes at least aplurality of like spaced slots 58 extending longitudinally along aportion of such a collet 44 defining, in part, a plurality of likespaced flexible jaws 60, each having a distally located tapered andarcuate surface 62 for collective simultaneous forced interaction withthe annular tapered actuating surface 54 of the torque body 42. Each ofthe like spaced flexible jaws 60 of the collet 44 has a proximallylocated tapered and arcuate surface 64 for collective simultaneousforced interaction with features of the collet nut 46, such featuresbeing later described in detail. Each of the like spaced flexible jaws60 includes a centrally located tapered arcuate surface 66, preferablyan inward taper, to accommodate the loading of the hypotube 22 from aproximal location. The tapered arcuate surfaces 66 of the collet 44adjoin a passageway 68 located between the innermost portions of theflexible jaws 60 and which passageway 68 adjoins a larger bore 70. Thepassageway 68 accommodates the hypotube 22 in coaxial fashion and thebore 70 accommodates the hypotube 22 and the proximal end of thedelivery sheath 16 in coaxial fashion. The proximal end of the deliverysheath 16 secures centrally within the bore 70 in alignment with thepassageway 68, such as by adhesive 71 or other suitable method. Thestrain relief 48 secures in the bore 50 of the torque body 42.

The collet nut 46 includes a centrally located bore 72 aligned withinternal threads 74 which accommodate the external threads 52 and theadjacent unthreaded proximal end of the torque body 42, respectively. Aninternal annular tapered surface 76 extends in a proximal direction fromthe internal threads 74. A passageway 78 adjoins the annular taperedsurface 76. An outwardly opening annular tapered passageway 80 adjoinsthe passageway 78. The tapered wall of the annular tapered passageway 80accommodates the insertion of the hypotube 22. In order to frictionallyengage the hypotube 22, the wall of the annular tapered surface 76maintains a forced intimate contact with the tapered and arcuatesurfaces 64 of the collet 44 in order to flex and force the collet jaws60 against the hypotube 22 in the passageway 68 in frictional engagementwhen the collet nut 46 and the torque body 42. Either the collet nut 46or the torque body 42 is rotated with respect to each other to draw thetorque body 42 and the collet nut 46 together about the collet 44. Thus,the torque handle 18 is engaged in frictional engagement with and aboutthe hypotube 22 in order that a unitary longitudinal and/or torquemovement of the infusion flow guidewire 12 and the delivery sheath 16can be accomplished within the vasculature.

Independent movement of the infusion flow guidewire 12 or of thedelivery sheath 16 with respect to each other or within the vasculaturecan be accomplished by loosening the collet nut 46 in order to releasethe frictional engagement of the torque handle 18 with the hypotube 22.Longitudinal and/or torque movement of the delivery sheath 16 can beaccomplished by grasping and actuating the torque body 42. Longitudinaland/or torque movement of the infusion flow guidewire 12 can beaccomplished without interference with the torque handle 18 by graspingand actuating the torque coupling assembly 14 which can be in frictionalengagement with the proximal end of the hypotube 22, as later describedin detail.

With reference to FIGS. 9, 10 and 11, each figure shows differentrelationships of components of the coupling assembly 14 to each other,to the high pressure supply line 20 and to the hypotube section 22. Suchrelationships and the structure of the components are now describedwhere FIG. 9 is an exploded isometric view of the torque couplingassembly 14, FIG. 10 is an exploded vertical cross section view of thecomponents shown in FIG. 9, and FIG. 11 is a view of the componentsshown in cross section in FIG. 10 arranged as an assembly.

The coupling assembly 14, which is removably attached to the hypotube 22of the infusion flow guidewire 12, is provided for rapid connection ofthe proximal end of the hypotube 22 of the infusion flow guidewire 12 toa high pressure supply device, such as the AngioJet® pump set or othersuitable device. The AngioJet® pump set is described in detail in patentapplication Ser. No. 11/237,558 filed Sep. 28, 2005, entitled“Thrombectomy Catheter Deployment System”. In particular, the couplingassembly 14 provides for communication and connection between theproximal end of the hypotube 22 to the distal end of the high pressuresupply line 20 which is connected to a high pressure supply device. Thecoupling assembly 14 includes a proximal knob 82 which generally isstationary with reference to an opposing distal knob 84. The distal knob84 is rotatable with reference to the proximal knob 82. The proximalknob 82 is indirectly connected to the distal end of the high pressuresupply line 20, as later described in detail. The distal knob 84 is usedfor removable attachment of the proximal end of the hypotube 22 toprovide communication of the hypotube 22 with the proximal end of thehigh pressure supply line 20, the latter being secured indirectly to theproximal knob 82.

A plurality of components, which components are substantiallystationary, is connected to and associated with the generally stationaryproximal knob 82 and include a threaded insert 85, set screws 86, athreaded body 88, an O-ring 90, and a compression fixture 92. Thestationary proximal knob 82 includes a longitudinally oriented centralbore 94 and opposed body holes 96 and 98 aligned perpendicular to andintersecting the bore 94 for accessing of the set screws 86. Thethreaded insert 85 is aligned in and is suitably secured within thecentral bore 94 of the proximal knob 82, such as by, but not limited to,the use of adhesives or frictional engagement. The threaded insert 85includes internal threads 100 and threaded holes 102 and 104 alignedperpendicular to and intersecting the internal threads 100 in order tofacilitate threaded engagement of the set screws 86 with the proximalend of the threaded body 88 to ensure secure fastening of the threadedbody 88 within the internal threads 100 of the threaded insert 85. Thethreaded body 88 includes external threads 106 with the proximal portionof the threads 106 threadingly engaging the threads 100 of the threadedinsert 85. The threaded body 88 also includes a partial bore 108 havingan internal annular end surface 109, a centrally located proximallyextending tubular flange 110, and a passageway 112 (FIG. 10), being partof the tubular flange 110 extending through the tubular flange 110 andconnecting to the bore 108. The distal end of the high pressure supplyline 20 is suitably secured to the tubular flange 110 within theproximal portion of the passageway 112 of the tubular flange 110, asshown in FIG. 11. The compression fixture 92 has a generally cylindricalshape and includes a passageway 114 extending along the longitudinalaxis thereof. The compression fixture 92 terminates proximally at anannular recess 116 and distally at an annular tapered actuating surface118. The annular recess 116 of the compression fixture 92 accommodatesthe O-ring 90. The compression fixture 92 aligns closely within the bore108 of the threaded body 88 and is longitudinally positionabletherewithin.

A plurality of components, which can be unitarily actuated in rotaryfashion, is connected to and associated with the distal knob 84including a threaded insert 120 and a tubular collet 122. The distalknob 84 includes a bore 124 terminating at an annular end surface 126and a passageway 128 having a taper 129 extending from the annular endsurface 126 through the distal wall of the distal knob 84 foraccommodation of the hypotube 22. The threaded insert 120 includes apartial bore 130 terminating at one end by an annular end surface 132and at the other end by adjacent threads 134. The threads 134progressively engage the distal portion of the external threads 106 ofthe threaded body 88. A passageway 136 extends from the bore 130 througha distal wall 138 of the threaded insert 120. The tubular collet 122includes a plurality of like spaced flexible jaws 140 each having atapered and arcuate surface 142 surrounding a centrally located multipleradius passageway 144. The threaded insert 120 is suitably securedwithin the bore 124 of the distal knob 84, such as, but not limited to,by the use of adhesives or frictional engagement. The tubular collet 122aligns to the annular end surface 132 of the threaded insert 120,whereby the passageway 144 of the tubular collet 122 and the passageway136 of the threaded insert 120 are in coaxial alignment.

The coupling assembly 14, which is removably attached to the hypotube 22of the infusion flow guidewire 12 and which is provided for rapidconnection to the proximal end of the hypotube 22 of the infusion flowguidewire 12, uses previously described structure to effect suitableconnection and coupling thereof and therewith. More specifically, thecomponents of the coupling assembly 14 are assembled, as shown in FIG.11, where the hypotube 22 is positioned, sealed and secured within thecoupling assembly 14. The hypotube 22 is shown in coaxial directalignment within the passageway 128 and taper 129 of the distal knob 84,the passageway 136 of the threaded insert 120, the passageway 144 of thetubular collet 122, the annular tapered actuating surface 118 of thecompression fixture 92, the passageway 114 of the compression fixture92, the center of the O-ring 90, and finally, within and incommunication with the passageway 112 of the threaded body 88 resultingin a suitable communication with the high pressure supply line 20. Asthe distal knob 84 is rotated and advanced proximally along the threads106 of the threaded body 88, the tube collet 122 is forcefullypositioned against the annular tapered actuating surface 118 of thecompression fixture 92, thereby urging and advancing the compressionfixture 92 proximally. During such urging and advancement, sealing andsecuring of the hypotube 22 within the coupling assembly 14 areaccomplished. Sealing is provided by the resultant advancement of thecompression fixture 92 to cause the O-ring 90, which is located in theannular recess 116 of the compression fixture 92, to bear against theannular end surface 109 of the threaded body 88 to deform the O-ring 90thereby effecting a seal about the hypotube 22, as well as perfecting aseal with the passageway 112 of the threaded body 88. A seal is alsoperfected between the bore 108 of the threaded body 88 and thepassageway 112 of the threaded body 88. Securing of the hypotube 22within the coupling assembly 14 is provided by the interaction of theadvancing tapered and arcuate surfaces 142 of the tubular collet jaws140 with the annular tapered actuating surface 118 of the compressionfixture 92, whereby the collet jaws 140 are forcibly urged inwardlyabout the longitudinal axis of the tubular collet 122 to frictionallyengage the hypotube 22. The engagement of the O-ring 90 about thehypotube 22 also provides for additional securement by frictionalengagement.

FIG. 12 illustrates a stainless steel extension wire 139 for use withthe preferred all nitinol wire infusion flow guidewire 12, including aconstant size body 141 and an irregular shaped distal end 143. Theirregular shaped distal end 143 can be inserted into the inner diameterof the nitinol infusion flow guidewire 12 to be engaged therein in lightfrictional engagement to easily and quickly convert a rapid exchangelength wire into an exchange length wire (for over-the-wire devices). Asshown in FIG. 12 a, another shape could be substituted for the irregularshaped distal end 143 including a tapered section 145 and a constantsize extension 147 which can frictionally engage the inner diameter ofthe infusion flow guidewire 12.

Alternatively, other configurations of the present invention can beadvantageous. First, an infusion flow guidewire can be fashioned where aproximal section of the nitinol hypotube 22 is replaced by a proximallylocated section of stainless steel hypotube joined to a shortened lengthof the nitinol tube, such as is used for the hypotube 22, instead of thefull length nitinol hypotube 22. The drawn hypotube section 22 a andcomponents located distally thereto remain unchanged. In thisconstruction, the proximal section of stainless steel structure providesa more pushable and torqueable proximal infusion flow guidewire end,thereby eliminating the need for and the use of the delivery sheath 16,as previously described. This approach requires a connection between thestainless steel hypotube section and the reduced length nitinol hypotubesection, such as those seen in the 0.014 inch guard dog device(application Ser. No. 11/581,613) or 3Fr swage proximal swage joint(application Ser. Nos. 11/702,990 and 11/702,995). The proximal end ofthe nitinol section could be drawn down and inserted in the distal innerdiameter of the stainless steel section and then swaging the stainlesssteel section over the drawn nitinol. Another configuration could beaccomplished by drawing the distal end of the stainless steel, goldplating it, and then laser swaging the proximal end of the nitinol ontothe distal stainless steel section. Such designs are more economicallyfeasible due to the reduction in the use of nitinol.

A second alternative construction involves the jet orifices. Thegreatest difficulty is achieving a high velocity and significant flowrate for the jet orifices. However, if one were to produce a series oforifices, 8-10 orifices for example, along the distal end of theinfusion flow guidewire 12, preferably on the collar 26, one couldproduce a weeping style infusion catheter similar to the Prostreamguidewire. The orifices could be proximally, distally or perpendicularlydirected in multiple combinations or arrangement thereof. In this case,the device would still have the advantage of a 0.014 inch profile versusthe 0.035 inch profile for the Prostream, but would be incapable ofconducting power pulse as previously described.

Thirdly, the connection for the pump to the infusion flow guidewirecould be of an alternative arrangement. Rather than using a screwmechanism to squeeze the O-rings about the flow wire, one could use ahinged handle on a cam to advance a pusher plate to squeeze the O-rings.

Mode of Operation

This invention describes a 0.014 inch infusion flow guidewire systemwhich can infuse fibrinolytics and which can also macerate and propelfluid or debris in a proximal direction. The guidewire system can beoperated with devices using an AngioJet® system in various forms ofimplementation for treatment of thrombus in small vessels, such as indistal peripheral vessels, e.g., foot or other neurovascular sites.Delivery of the infusion flow guidewire 12, preferably of 0.014 inchdiameter, is facilitated by inserting the delivery sheath 16 into andalong the vasculature to position the distal end of the delivery sheath16 at a location in close proximity to a thrombus site. Such positioningis facilitated by grasping the torque handle 18 and urging the deliverysheath 16 distally. Then, the flexible tip 24 of the infusion flowguidewire 12 can be inserted into and engage the proximal end of thetorque handle 18, and thence, gain entry into the delivery sheath 16,whereby the hypotube 22 and the flexible tip 24 can be positioneddistally therein by the use of the attached coupling assembly 14. In thealternative, the infusion flow guidewire 12 can be prepackaged in thedelivery sheath 16 for unitary delivery. When delivery is accomplished,fibrinolytics can be introduced or maceration of thrombus can take placein conjunction with an AngioJet® system, such as disclosed in patentapplication Ser. No. 11/237,558 filed Sep. 28, 2005, entitled“Thrombectomy Catheter Deployment System,” or with other AngioJet®systems. As previously described, the torque handle 18 can be tightenedover and about the hypotube 22 and unitary longitudinal and rotarypositioning of the infusion flow guidewire 12 including the hypotube 22can be accomplished. The clamping action of the torque handle 18 can beterminated by loosening the collet nut 46, whereby the infusion flowguidewire 12 can be longitudinally and rotatingly positionedindependently of the delivery sheath 16 by use of the attached couplingassembly 14 to achieve the desired position. When the infusion flowguidewire 12 is in the desired position, the coupling assembly 14 can berotationally actuated to release the proximal end of hypotube 22 at theproximal end of the infusion flow guidewire 12 to allow separation ofthe hypotube 22 and the coupling assembly 14, thereby allowing accessover and about the infusion flow guidewire 12 by other devices, asnecessary.

FIGS. 13, 14 and 15 show various locations of the jet orifices 32 and 34with respect to the thrombus 148 located in a vessel 150, such locationsbeing used for various operating modes. FIG. 13 shows the location ofthe jet orifices 32 and 34 in close proximity to and proximal to thethrombus 148, FIG. 14 shows the location of the jet orifices 32 and 34in close proximity to and distal to the thrombus 148, and FIG. 15 showsthe location of the jet orifices 32 and 34 aligned within the thrombus148.

Preferably, the invention is used with and is connected to an AngioJet®system. The invention may be used either to inject fibrinolytics, tomacerate and propel fluid or debris in a proximal direction, or toaccomplish all or other such functions. A hypothetical procedure, suchas for use in the foot, for example, may be to advance the infusion flowguidewire to this very distal anatomy, farther than currently possiblewith available thrombectomy catheters. As shown in FIG. 13,fibrinolytics 146 can be delivered at a nominal rate, such as by use ofan AngioJet® system, in close proximity to the proximal portion of abuildup of thrombus 148 located in the vessel 150 for the treatment andsoftening of the thrombus prior to thrombus removal.

As shown in FIG. 14, the jet orifices 32 and 34 can be positioned inclose proximity and distal to the thrombus 148 where an AngioJet® systemcan deliver fibrinolytic at a nominal rate or in the power pulse mode,the latter mode of which proximally directs and infuses a fibrinolyticto the thrombus 152 of the thrombosed vessel segment in a direction asshown by arrows 152. This will ensure that the fibrinolytic is driveninto the organized thrombus debris for effective loosening of thethrombus 148. Following a period of time, the physician would operatethe same infusion flow guidewire 12 to macerate the organized debris byhigh pressure jet streams emanating proximally from the jet orifices 32and 34 in a direction shown by arrows 152 The net effect of theprocedure is that any thrombus 148 that would have been removed by along duration drip is removed in the catheterization laboratory with thepower pulse technique. This avoids the need to keep patients on a longterm drip of fibrinolytics which is undesirable from a bleedingcomplication perspective. The flow rate and the jet orifice 32 and 34arrangement of the infusion flow guidewire 12 result in a power directinfusion of fluid sufficient to disrupt and macerate the thrombus orpush debris in the direction of the jet flow subsequent to breakingthrough the thrombus 148. Preferably, the infusion flow guidewire 12 isactuated in a to and fro motion, as well as a rotary motion.

As shown in FIG. 15, the jet orifices 32 and 34 are positioned in themidst of the thrombus 148. Again, an AngioJet® system can be used todeliver fibrinolytics under nominal pressure or under power pulsepressures. Such a location of the jet orifices 32 and 34 can beadvantageous in treatment at the center of the thrombus 148 from theinside to the outside thereof. After a suitable length of time, highpressure jet streams emanating from the jet orifices 32 and 34 in adirection as shown by arrows 152 macerate the thrombus 148. Preferably,the infusion flow guidewire 12 is actuated in a to and fro motion, aswell as a rotary motion.

An aspiration catheter or an AngioJet® catheter, such as one with aproximal balloon, could be delivered over the infusion flow guidewire 12and connected an AngioJet® system roller pump. Thus, the infusion flowguidewire system 10 could conduct thrombus maceration coupled withaspiration. Although the infusion flow guidewire system 10 may not betruly isovolumetric, there would be some aspiration of the material.Furthermore, the high velocity fluid jet stream from the infusion flowguidewire 12 is generally effective in macerating debris. Finally, oncethe debris is removed, there may need for other treatments. For example,a stent could be delivered over the same wire following thethrombectomy/lysis procedure. Other techniques for use of the infusionflow guidewire 12 would be to first treat the thrombus segment with the“Power Pulse” technique. Following this procedure, a pressurized bag ofsaline/lytic could be attached to the infusion flow guidewire 12 and thepatient moved out of the catheterization laboratory.

Alternatively, the physician may elect to only conduct a drip typeprocedure with the infusion flow guidewire 12 or a nominal pressure slowinfusion could be accomplished with an AngioJet® system. There are manypotential treatment modalities. The AngioJet® system along with itscapability of delivering fluid at pressures up to 20 kpsi, can enablethe 0.014 inch infusion flow guidewire 12 to deliver a powerful streamof fluid sufficient to the treatment site, if required.

The entire infusion flow guidewire 12 is fashioned of nitinol toeliminate any flow restrictions between nitinol tubing and previouslyused stainless steel tube components and associated joint restrictions,as well as wall thickness strength constraints. The use of nitinoltubing also makes the infusion flow guidewire 12 kink resistant. Thegoal of the infusion flow guidewire system 10 is to enable delivery ofas much a flow rate as possible to the jet orifices 32 and 34. Theresulting flow rate, divided by the jet hole area, will yield the jetvelocity. Vessel safety tests have shown that jet velocity higher thanthe AngioJet® catheter side exhaust holes (15 m/s) are safe, but thatthe velocities must be less than the AngioJet® internal jets (150 m/s).However, there may be occasions where destructive velocities in excessof 150 m/s may be required in treatment of calcific plaque, tissuedestruction or disruption. Hence, the jet hole diameter and the entireflow resistance of the device is engineered to yield jet velocities inthe range of 15 to 100 m/s. Aside from connections between stainlesssteel and nitinol, there may be other major restrictions that requireattention. First, the infusion flow guidewire 12 should preferably be arapid exchange length of 190 cm in order to achieve the least resistanceas possible. Secondly, the ID of the nitinol infusion flow guidewire 12should be as large as practical preferably 0.010 inch diameterdimension. Third, the drawn hypotube section 22 a at the distal end ofthe infusion flow guidewire 12 is designed as short as possible in orderto achieve an acceptably deliverable infusion flow guidewire.Importantly, an infusion flow guidewire 12 device of 0.014 inch candeliver a significant flow rate (>5 cc/min) to the jet orifices 32 and34 using a typical AngioJet® pressure range of 0.25 kpsi to 12 kpsi.

Various modifications can be made to the present invention withoutdeparting from the apparent scope thereof.

It is claimed:
 1. An infusion flow guidewire comprising: a flexible hypotube having a lumen, a proximal end, a distal end, and a drawn hypotube section located at the distal end, wherein the drawn hypotube section has a diameter less than a diameter of the flexible hypotube; a reinforcement collar having a lumen, a proximal end, and a distal end, wherein a region of the drawn hypotube section of the flexible hypotube extends through the lumen of the reinforcement collar; at least one proximally directed jet orifice comprising a hole in the reinforcement collar and an aligned hole in the drawn hypotube section of the flexible hypotube which allows fluid communication from the lumen of the drawn hypotube section of the flexible hypotube; a flexible coil attached to and extending distally from the reinforcement collar, wherein a portion of the drawn hypotube section of the flexible hypotube which extends distally from the reinforcement collar lies within a lumen of the flexible coil; a core wire secured within the lumen at the distal end of the flexible hypotube and extending distally therefrom, wherein the core wire has a proximal end located distally from the reinforcement collar, the core wire coaxially aligned within the lumen of the flexible coil and having a proximally located round section, a distally located flat section and a tapered transition section therebetween, a distal end of the core wire terminating in a weld to the distal end of the flexible coil; and, wherein the flexible coil located distally from the drawn hypotube section of the flexible hypotube and the core wire located distally from the drawn hypotube section of the flexible hypotube and the weld therebetween together define a flexible tip.
 2. (canceled)
 3. (canceled)
 4. The infusion flow guidewire of claim 1, wherein the reinforcement collar is secured to the drawn hypotube section of the flexible hypotube by at least one laser weld.
 5. The infusion flow guidewire of claim 4, wherein the at least one laser weld is one of two laser welds securing the reinforcement collar to the drawn hypotube section and the two laser welds are located near the distal end and near the proximal end of the reinforcement collar.
 6. The infusion flow guidewire of claim 1, wherein the hole in reinforcement collar and the hole in the drawn hypotube section of the flexible hypotube are formed by electrical discharge machining. 7-9. (canceled)
 10. The infusion flow guidewire of claim 1, wherein the core wire is secured to an inner wall surface of the lumen of the drawn hypotube section of the flexible hypotube.
 11. The infusion flow guidewire of claim 1, wherein the core wire is secured to an inner wall surface of the lumen of the drawn hypotube section of the flexible hypotube by at least one laser swage.
 12. The infusion flow guidewire of claim 1, wherein the flexible tip is more flexible than the drawn hypotube section of the flexible hypotube. 13-16. (canceled)
 17. The infusion flow guidewire of claim 1, wherein the flexible hypotube has a proximal extension of stainless steel tubing. 18-37. (canceled)
 38. An infusion flow guidewire system comprising: a flexible infusion flow guidewire including a flexible tip section, and an elongated flexible hypotube for delivering a pressurized liquid to a thrombus in a vessel or artery, said elongated flexible hypotube having a proximal end, a distal end, and at least one jet orifice near said distal end for expelling said pressurized liquid therefrom; a torque handle having a lumen, a distal end and a proximal end, said torque handle being connected to said elongated flexible hypotube; and a torque coupling assembly having a proximal end and a distal end, said torque coupling assembly being connected to a high pressure, tubular, liquid supply line on said proximal end thereof and to said elongated flexible hypotube on said distal end thereof, wherein said elongated flexible hypotube extends from said torque coupling assembly to said proximal end of said torque handle, passing through said lumen of said torque handle and extends externally from said distal end of said torque handle to said flexible tip section.
 39. The infusion flow guidewire system of claim 38, wherein said flexible infusion flow guidewire further includes: an elongated flexible delivery sheath surrounding said elongated flexible hypotube and extending internally from within said lumen of said torque handle towards said flexible tip section of the flexible infusion flow guidewire, said elongated flexible delivery sheath being fixed near the proximal end of said torque handle.
 40. The infusion flow guidewire system of claim 38, wherein said elongated flexible hypotube further includes a drawn-down section extending in a distal direction; and a cylindrical reinforcement collar surrounding and fixed to a portion of said drawn-down section of said elongated flexible hypotube, wherein the at least one proximally directed jet orifice comprises a hole in said drawn-down section and an aligned hole in said cylindrical reinforcement collar, said jet orifice configured to expel said pressurized fluid in a rearward direction.
 41. The infusion flow guidewire system of claim 40, wherein said cylindrical reinforcement collar is fixed to said portion of said drawn-down section of said elongated flexible hypotube by a plurality of laser welds.
 42. The infusion flow guidewire system of claim 40, wherein a flexible core wire is fixed within a distal portion of said drawn-down section of said elongated flexible hypotube and extends from said distal end thereof a predetermined distance terminating at a weld at a distal end of said flexible tip section of said a flexible infusion flow guidewire.
 43. The infusion flow guidewire system of claim 42, wherein said flexible core wire is cylindrically shaped for a major portion thereof and substantially flat the remainder thereof terminating in said weld.
 44. (canceled)
 45. The infusion flow guidewire system of claim 42, wherein an elongated flexible coil surrounds a substantial portion of said drawn-down section of said elongated flexible hypotube and surrounds said extended portion of said flexible core wire and terminates in said weld.
 46. The infusion flow guidewire system of claim 45, wherein said elongated flexible coil is attached to said drawn-down section of said elongated flexible hypotube by soldering, welding or otherwise suitably attached.
 47. (canceled)
 48. The infusion flow guidewire system of claim 45, wherein said cylindrical reinforcement collar has a proximal end and a distal end and wherein said elongated flexible coil has a proximal end and a distal end, said proximal end of said elongated flexible coil being adjacent to said distal end of said reinforcement collar and said distal end of said elongated flexible coil terminating in said weld.
 49. The infusion flow guidewire system of claim 39, wherein said elongated flexible hypotube and said elongated flexible delivery sheath, either separately or together, are secured within said lumen of said torque handle such that they can be rotated or longitudinally moved in a distal or a proximal direction.
 50. The infusion flow guidewire system of claim 38, wherein said torque handle further includes a substantially tubular torque body with a proximal end, a distal end, a central bore, and external threads at said proximal end thereof; a collet having a distal end, a proximal end with flexible jaws, and a tubular member extending distally from said proximal end, wherein said collect is inserted into said central bore at said proximal end of said tubular torque body; and, a nut having internal threads therein for cooperating with said external threads of said tubular torque body to cause, when said nut and tubular body are twisted relative to each other, a horizontal movement between said tubular torque body and said nut resulting in the clamping or releasing of said elongated flexible hypotube between said flexible jaws of said collet.
 51. The infusion flow guidewire system of claim 50, wherein said tubular torque body further includes: a strain relief tube partially inserted and fixed within said distal end of said tubular torque body and extending externally a short distance beyond said distal end of said tubular torque body.
 52. The infusion flow guidewire system of claim 38, wherein said torque coupling assembly further includes: a stationary knob having a central bore therethrough, wherein the stationary knob is located at a proximal end of the torque coupling assembly; a first internally threaded insert partially fixed within said central bore of said stationary knob; a rotatable knob having a central bore, wherein the rotatable knob is located at a distal end of the torque coupling assembly; a second internally threaded insert embedded in said central bore of said rotatable knob, an elongated tubular member having an external thread along its entire length, said elongated tubular member having a proximal end and a distal end, said external threads adjacent said proximal end of said elongated tubular member engaging said internal threads of said first internally threaded insert and said external threads adjacent said distal end of said elongated tubular member engaging said internal threads of said second internally threaded insert, said elongated tubular member having a central bore therein which opens at said distal end of said elongated tubular member and terminates in a proximal direction at a surface wall within said central bore of said elongated tubular member, said elongated tubular member having a tubular flange extending from said proximal end thereof, said elongated tubular member having a smaller central bore therein which begins from said surface wall within said central bore of said elongated tubular member and extends through said tubular flange; an elongated compression tube being inserted within said central bore of said elongated tubular member, said elongated compression tube having a proximal end, a distal end, and a central bore therethrough with a diameter slightly greater than the outer diameter of said elongated flexible hypotube passing therethrough, a partial bore being defined between said distal end of said elongated tubular member and an internal surface of said first internally threaded insert, a tubular collet sandwiched between an internal surface of said central bore of said first internally threaded insert and an external surface at said distal end of said elongated compression tube, and said tubular collet having a plurality of flexible jaws and a plurality of arcuate surfaces interfacing an annual tapered surface at said distal end of said elongated compression tube.
 53. The infusion flow guidewire system of claim 52, wherein said elongated compression tube has an annular recess at said proximal end thereof and a compressible O-ring inserted therein and interfacing said surface wall within said central bore of said elongated tubular member.
 54. The infusion flow guidewire system of claim 52, wherein said first internally threaded insert has at least one threaded hole in a peripheral wall and an externally threaded set screw engaging said at least one threaded hole. 55-57. (canceled)
 58. The infusion flow guidewire system of claim 38, wherein said pressurized liquid is delivered to said elongated flexible hypotube at a pressure exceeding 0.25 kpsi at a flow rate of 5 cc/min.
 59. (canceled)
 60. The infusion flow guidewire system of claim 50, wherein said elongated flexible delivery sheath is secured within said tubular torque member remote from said flexible jaws of said collet and near said distal end of said collet by an adhesive.
 61. The infusion flow guidewire system of claim 39, wherein said torque handle includes means for simultaneously or individually rotating or longitudinally moving said elongated flexible hypotube and said elongated flexible delivery sheath.
 62. The infusion flow guidewire system of claim 38, wherein said torque coupling assembly includes means for rotationally or longitudinally moving said elongated flexible hypotube.
 63. An infusion flow guidewire system comprising: a flexible infusion flow guidewire including a flexible hypotube having a lumen, a proximal end, a distal end, and a drawn hypotube section located at the distal end, wherein the drawn hypotube section has a diameter less than a diameter of the flexible hypotube, a reinforcement collar having a lumen, a proximal end, and a distal end, wherein a region of the drawn hypotube section of the flexible hypotube extends through the lumen of the reinforcement collar, at least one proximally directed jet orifice comprising a hole in the reinforcement collar and an aligned hole in the drawn hypotube section of the flexible hypotube which allows fluid communication from the lumen of the drawn hypotube section of the flexible hypotube, a flexible coil attached to and extending distally from the reinforcement collar, wherein a portion of the drawn hypotube section of the flexible hypotube which extends distally from the reinforcement collar lies within a lumen of the flexible coil, and a core wire secured within the lumen at the distal end of the flexible hypotube and extending distally therefrom, wherein the core wire has a proximal end located distally from the reinforcement collar, the core wire coaxially aligned within the lumen of the flexible coil and having a proximally located round section, a distally located flat section and a tapered transition section therebetween, a distal end of the core wire terminating in a weld to the distal end of the flexible coil, wherein the flexible coil located distally from the drawn hypotube section of the flexible hypotube and the core wire located distally from the drawn hypotube section of the flexible hypotube and the weld therebetween together define a flexible tip; a torque handle having a lumen, a distal end and a proximal end, said torque handle being connected to said flexible hypotube; and a torque coupling assembly having a proximal end and a distal end, said torque coupling assembly being connected to a high pressure, tubular, liquid supply line on said proximal end thereof and to said flexible hypotube on said distal end thereof, wherein said flexible hypotube extends from said torque coupling assembly to said proximal end of said torque handle, passing through said lumen of said torque handle and extends externally from said distal end of said torque handle to said flexible tip.
 64. The infusion flow guidewire system of claim 63, wherein said flexible infusion flow guidewire further includes: an elongated flexible delivery sheath surrounding said flexible hypotube and extending internally from within said lumen of said torque handle towards said flexible tip of the flexible infusion flow guidewire, said elongated flexible delivery sheath being fixed near the proximal end of said torque handle. 